Glycated Albumin and Adverse Clinical Outcomes in Patients With CKD: A Prospective Cohort Study

Area of Science:

• Nephrology
• Endocrinology
• Cardiovascular Medicine

Background:

• Hemoglobin A1c (HbA1c) is a standard glycemic measure but less reliable in chronic kidney disease (CKD).
• Glycated albumin (GA) is emerging as a complementary marker for glycemic monitoring in CKD.
• The association of GA with clinical outcomes in non-dialysis-dependent CKD is not well-established.

Purpose of the Study:

• To investigate the association between baseline glycated albumin (GA) levels and clinical outcomes in a cohort of patients with non-dialysis-dependent CKD.
• To determine if GA provides prognostic information independent of or in addition to HbA1c.

Main Methods:

• Prospective cohort study of 3,110 participants with CKD from the Chronic Renal Insufficiency Cohort study.
• Baseline glycated albumin (GA) levels were measured.
• Cox proportional hazards regression was used to analyze associations with incident end-stage kidney disease (ESKD), cardiovascular disease (CVD) events, and all-cause mortality.

Main Results:

• Higher GA levels were associated with increased risks of ESKD, CVD, and mortality in CKD patients, irrespective of diabetes status.
• The associations between GA and CVD/mortality exhibited a J-shaped pattern.
• GA provided significant prognostic information, particularly when added to HbA1c models in patients with coexisting CKD and diabetes.

Conclusions:

• Glycated albumin is an independent predictor of adverse outcomes, including ESKD, CVD, and mortality, in patients with non-dialysis-dependent CKD.
• GA enhances the prognostic capability of HbA1c for risk stratification in CKD patients, especially those with diabetes.
• GA may serve as a valuable complementary biomarker for glycemic management and risk assessment in the CKD population.